Selection of ambulatory ECG recording technique
Recorder type
Advantages
Disadvantages
Duration of use
Holter monitor
1. Continuous ECG Recording
2. No activation required by patient
3. Preferred method for daily symptoms
1. Less useful for infrequent symptoms
2. Continuous monitoring at times uncomfortable/inconvenient for patients
24–48 h
Noninvasive event monitor
1. Intermittent ECG Recording
2. Transtelephonic downloading of events for immediate assessment
3. Preferred for infrequent symptoms (weekly or monthly) without causing loss of consciousness
1. ECG wires must be attached and activated by patient with each event
2. Less useful for brief symptoms
3. Less useful for arrhythmias that cause loss of consciousness
Weeks – Months
Loop monitor
1. Intermittent ECG Recording
2. Transtelephonic downloading of events for immediate assessment
3. Preferred for infrequent or brief symptoms that may cause loss of consciousness
1. Continuous wearing required
2. Recorder must be activated by patient with each event
Weeks – Months
Implantable loop recorder (ILR)
1. Continuous monitoring with intermittent ECG recording up to 40 min
2. Preferred for rare symptoms which cause loss of conciousness
1. Must be surgically inserted
2. Risk of infection
3. Higher cost than other noninvasive techniques
Up to 3 years
Indications for AECG are summarized in the ACC/AHA Guidelines for Ambulatory Electrocardiography [2]. Common indications for its use include palpitations, unexplained syncope, and ischemia detection in patients with suspected variant angina (Table 19.2). In addition, AECG may be utilized in special circumstances for antiarrhythmic drug monitoring and the assessment of pacemaker and Implantable Cardioverter-Defibrillator (ICD) function (Table 19.3). Other indications for ambulatory monitoring include assessment of the average heart rate and adequacy of rate control in patients with atrial fibrillation. Increasingly, techniques of ambulatory monitoring are being used to evaluate for otherwise undetected atrial fibrillation in patients presenting with cryptogenic stroke. Ambulatory monitoring techniques can also be used to screen patients for asymptomatic premature ventricular contractions and nonsustained ventricular tachycardia for purposes of risk stratification. AECG can provide useful information for risk stratification for sudden cardiac death in selected patients. These include those patients with hypertrophic cardiomyopathy, long QT syndrome, congenital heart disease, arrhythmogenic right ventricular dysplasia, ischemic heart disease, and dilated cardiomyopathies
Table 19.2
Indications for AECG to assess symptoms possibly related to rhythm disturbances
A. Indications for AECG to assess symptoms possibly related to rhythm disturbances | |
Class I | 1. Unexplained syncope, near syncope, or episodic dizziness in whom the cause is not obvious 2. Unexplained recurrent palpitations |
Class IIb | 1. Episodic shortness of breath, chest pain, or fatigue that is not otherwise explained 2. Neurological events when transient atrial fibrillation of flutter is suspected 3. Syncope, near syncope, episodic dizziness, or palpitations in whom a probable cause other than an arrhythmia has been identified, but in whom symptoms persist despite treatment |
Class III | 1. Syncope, near syncope, episodic dizziness, or palpitations in whom other causes have been identified 2. Cerebrovascular accidents without other evidence of arrhythmia |
B. Indications for AECG for ischemia monitoring | |
Class I | None |
Class IIa | Patients with suspected variant angina |
Class IIb | 1. Evaluation of patients with chest pain who cannot exercise 2. Preoperative evaluation for vascular surgery of patients who cannot exercise 3. Patients with known coronary artery disease and atypical chest pain syndrome |
Class III | 1. Initial evaluation of patients with chest pain who are able to exercise 2. Routine screening of asymptomatic patients |
Table 19.3
Indications for AECG to assess antiarrhythmic drug and device therapy
A. Indications for AECG to assess antiarrhythmic drug therapy | |
Class I | To assess antiarrhythmic drug response in individuals in whom baseline frequency of arrhythmia has been characterized as reproducible and of sufficient frequency to permit analysis |
Class IIa | To detect proarrhythmic responses to antiarrhythmic therapy in patients at high risk |
Class IIb
 Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
| |